MEDICARE: AMANDA SUSAN HELD MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	111201	CA

General Provider Information

NPI Number	:	1932788866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA SUSAN HELD MSW, LCSW

Provider Business Mailing Address
First Line	:	4420 HOTEL CIRCLE CT STE 205
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3423
Country	:	US
Telephone Number	:	833-426-0754
Fax Number	:

Provider Business Practice Location Address
First Line	:	4420 HOTEL CIRCLE CT STE 205
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3423
Country	:	US
Telephone Number	:	833-426-0754
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2021
Last Update Date	:	08/12/2024

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